Icknield Court

Icknield Court is a residential care home registered to provide personal care and support for up to 90 people aged 65 and over, some of whom are living with dementia. There were 37 people living at the home at the time of the inspection. People’s living accommodation is across two floors, each floor had separate areas called houses. There were six houses in total. Each house had seating areas, dining space and kitchen facilities. People had individual bedrooms with level access shower and toilet facilities. We observed people had free access to a large courtyard area. The home was bright and well- maintained.

People’s experience of using this service and what we found

People told us they felt safe living at the home. Comments included “Yes, I think I feel safe, very safe, living here, it is the right environment for me”, “I think we know that we are in a safe home and in safe hands”. Another person told us “I am 95 years old and I know that I could move and live here (permanently) … and I would be comfortable here, at the moment I wouldn’t change anything here and if something is wrong you only have to open your mouth and it is usually done”.

Records we viewed were not routinely consistent, accurate and complete. We found some further improvements were required to ensure people’s records reflected their needs and were updated in a timely manner.

People were not routinely supported by staff who ensured robust medicine management was in place or best practice guidance was followed. We found improvements were required in the records held about people’s prescribed medicines.

Each person had care plans in place for staff to follow, which describes their likes and choices. However, where people were staying short term at the home, these care plans were less comprehensive. We have made a recommendation about this in the report.

People were supported by staff who had been recruited safely and had been provided with training and support to ensure they had the right skills and attributes to work with them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the home supported this practice.

People were supported by a management team who were keen to ensure they experienced a good level of well-being. The registered manager had supported staff to understand the expected level of quality of care to be provided to people. We received positive feedback about the management team.

The home management team worked well with external healthcare professionals. One GP commented “Understanding of residents’ needs and medical conditions has been excellent”.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 23 September 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

At this inspection we found some improvements had been made, however we found enough improvement had not been sustained and the provider was still in breach of regulations.

This service has been in Special Measures since December 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17, 18 and 19 September 2019. Breaches of legal requirements were found. We took enforcement action and issued warning notices for regulation 12 and 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person-centred care, support for staff and good governance. We carried out a focused inspection on 29 and 30 July 2020 to check if the warning notices had been met. We found the provider was still in breach of regulations in the areas of safe care and treatment and good governance. Following the focused inspection, a decision was made not to escalate any enforcement. We took into account the impact of the COVID 19 pandemic.

We undertook this focused inspection to check what action had been made since the last inspection and to confirm the service’s compliance with legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

Enforcement

We have identified breaches in relation to medicine management and good record management at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Icknield Court on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Icknield Court is a residential care home registered to provide personal care and support for up to 90 people. aged 65 and over. There were 50 people using the service at the time of the inspection.

The service accommodates people across two floors, each of which have separate adapted facilities. There were six 'houses' or 'units', three of which specialised in providing care to people living with dementia. At the time of the inspection two of the units were not being used to accommodate people.

People’s experience of using this service and what we found

People were not always supported to keep safe. Risks to people’s health and welfare were not routinely managed in a way that protected people from harm. Monitoring records such as repositioning, food and fluid charts and weight monitoring charts for people who were at risk of malnutrition were not always fully completed. In addition, staff were not always following the advice of healthcare professionals in relation to preventing and treating pressure ulcers.

People were not always supported by staff who followed best practice in the safe administration of medicines. Prior to and after our inspection we were alerted to a high number of medicines errors by the local authority. Although we did not find any medicines errors on the day of our inspection we did observe unsafe practice. During a medicines round where a member of staff did not wear gloves or wash their hands in between administering medicines to people. We also found that the controlled drugs register had not been completed accurately.

Accidents and incidents had not always been analysed so that lessons could be learnt, and action taken to prevent similar incidents from reoccurring.

Good systems were in place to prevent and control the spread of infection and the provider was following government guidance in relation to the Covid-19 pandemic.

There were robust staff recruitment systems in place and there were enough staff appropriately deployed to meet the needs of people using the service. Staff were committed to providing good care however, they were not receiving adequate support, guidance and monitoring from the management team to ensure they were effective in their roles.

The governance systems were ineffective and although some issues had been identified by the provider there were serious shortfalls at the time of our inspection that meant we could not be assured that people would receive safe and appropriate care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 20 January 2020) and there were multiple breaches of regulation. We served two warning notices following the inspection for Safe Care and Treatment and Good Governance. Following the inspection, the provider sent us an action plan telling us how they were going to address the shortfalls identified. During this inspection we found the warning notices had not been met and there were still breaches of regulation in relation to Safe Care and Treatment and Good Governance. The service remains inadequate.

Why we inspected

The inspection was prompted in part due to concerns received in relation to the management of medicines and people’s care needs. We also needed to check what improvements had been made since the last inspection to address the breaches of regulation.

We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Icknield Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment and good governance at this inspection.

Considering the exceptional circumstances, we have decided not to take any further enforcement action at this time. Following the inspection, we met with the provider and they have engaged external support to help drive improvement at the service. The provider has demonstrated a commitment to driving improvement at the service and will provide an action plan that will be monitored by us. A further inspection will take place shortly to ensure the required improvements have been made.

Follow up

We will continue to monitor information we receive about the service and the provider’s action plan. We will then return and carry out a further inspection to ensure that the required improvements have been achieved. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. We will keep the service under review and will re-inspect in due course to check for significant improvements.

If the provider has not made enough improvement when we next inspect and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Icknield Court is a residential care home providing personal and nursing care up to 90 people. The service accommodates people across two floors, each of which have separate adapted facilities. There were six 'houses' or 'units', three of which specialised in providing care to people living with dementia. At the time of our inspection 81 people were using the service.

People’s experience of using this service and what we found

Medicines were not managed safely and placed people at risk of not receiving the correct medicine at the right time. Some people had not received their medicines due to insufficient stock. People did not receive the support they required in a timely manner. Call bells were not always within people’s reach to ensure they could call for help if they needed it. Risk assessments and care plans did not provide staff with all the information they required to keep people safe. Accidents and incidents had not been analysed so that lessons could be learnt, and preventative action taken.

Best practice guidance was not followed to ensure people received good quality care and support. Staff training was not up to date and therefore we could not be sure that staff had the skills and knowledge they required to carry out their role. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

Information about people’s preferences was minimal. Care plans did not contain vital information to keep people safe.

The governance systems were poor and although some issues had been identified by the provider there were serious shortfalls at the time of our inspection that meant we could not be assured that people would receive safe and appropriate care.

Complaints had been recorded and responded to. End of life care was provided. However, staff had not received training in this area.

Recruitment procedures had been followed to ensure staff were suitable to work with vulnerable people. People had sufficient food and drink. A variety of activities were provided to ensure people were not socially isolated. People were supported to attend healthcare appointments.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 2 August 2018). There were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to unsafe management of medicines, safe care and treatment, providing personalised care, staffing and governance. We have served warning notices in relation to safe care and treatment and good governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found that staff had not received appropriate support, training and appraisal to enable them to carry out the duties they were employed to perform. We found during this inspection the provider had made improvements and were now meeting this regulation. However, we found the service was in breach of other regulations during this inspection. This was in relation to good governance and consent. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in effective and well led to at least good.

Icknield Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Icknield Court accommodates 90 people in one adapted building. The service accommodates people across two floors, each of which have separate adapted facilities. There were six ‘houses’ or ‘units’, three of which specialised in providing care to people living with dementia. At the time of our inspection 87 people resided in the service. Four people received respite care.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, a new manager was in the process of applying to become the new registered manager.

People were kept safe at the service. Staff had received training in safeguarding people from abuse and staff told us they would not hesitate in reporting any concerns regarding people’s welfare to the relevant authority.

We observed there were sufficient staff to support people at the time of our inspection. We saw that staff treated people with kindness and compassion. Comments included, “We all seem to be looked after properly here”, “They do come quickly if you press your buzzer”, “It is as close to being in your own home as it can be”.

Staff told us they felt supported and had received supervisions from their line manager. Appraisals had been carried out in line with the providers policy and procedures.

Risk assessments had been carried out for people with an identified risk, for example, repositioning for people with frail skin and fluid monitoring for people at risk of dehydration. However, the charts we saw were not always completed and some charts had not been completed at all.

We saw that recording of incidents such as bruising or skin tears were recorded in the handover record. However, it was not clear how these incidents were monitored. The service did not have an effective system relating to recording when bruising or skin tears occurred.

Medicines were mainly well managed. We observed the administration of medicines during our inspection and found people were safe from harm. Where medicine incidents occurred, these were investigated and address to prevent further occurrences. We saw that where people required regular pain relief to manage their pain a monitoring chart was not in place to establish the effects of the medicine. However, the manager told us this is something they will be addressing.

The service did not follow the requirements of the Mental Capacity Act 2005 (MCA). We found recordings of consent and best interest decisions were not always in place this meant the service did not comply with the MCA codes of practice. We did not find clear information in relation to people’s applications, reviews and expiry dates for standard DoLS authorisations.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the service policies and procedures did not support this practice.

People’s nutritional needs were met and appropriate measures were in place where people were at risk of malnutrition. There was good partnership working with community specialists to monitor people’s well-being.

Care plans were under review at the time of our inspection. We saw old versions of care plans and the new versions. We found conflicting information in the care plans we viewed. Some contained out-of-date information and changes to people’s care was not always documented. We saw reviews which stated no changes. However, further information provided, confirmed this was not the case.

People had a range of activities to take part in to provide social stimulation. The service employed activity coordinators and local volunteers who provided a programme of activities.

Auditing of the quality of care took place. However, actions from the audits were still outstanding at the time of our visit.

We found two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We previously inspected the service on 14 April 2015. The service was meeting the requirements of the regulations at that time.

Icknield Court provides care for up to 90 people, including people with dementia. Eighty people were living at the home at the time of our inspection. The building was divided into separate units or ‘houses.’ Three houses provided specific care to people whose primary care needs were associated with dementia.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager was in post; they were in the process of applying to become registered.

People were kept safe at the service. Thorough recruitment processes were used when appointing new staff. The premises were well maintained; appropriate checks were made to ensure it was kept in good order. There had been a satisfactory fire inspection in November 2016 and the service had been awarded the highest, five star rating for food hygiene practices.

There were enough staff to support people at the time of our visit. We observed staff treated people with empathy and warmth; people we spoke with were complimentary of staff. Comments included “The staff are really lovely, very kind,” “Everyone is ever so kind to me. I love it, I really love it” and “ The staff are lovely.” A relative said “I couldn’t have found a better place. The staff are lovely. I’ve got no worries at all.” They added their relative was “Always clean, never wet. If I go away I have no worries.” They told us “What I like is the staff sit down with them at mealtimes and eat with them.”

Staff received supervision from their line managers, to look at how they were working and discuss their development. However, they did not always receive support in other areas. For example, we found gaps to training records where courses had not been undertaken or were overdue for renewal. Annual appraisals had last been carried out three to four years ago in the files we checked. This meant staff had not received support in line with the provider’s expectations for developing workers.

People’s nutritional needs were met and appropriate measures were in place where people were at risk of weight loss. People received the healthcare support they required. There was good partnership working with GP surgeries and community specialists to keep people healthy and well. Two healthcare workers told us the home supported people well at end of life. One commented “I have also been impressed with the care they have offered families in the immediate aftermath of a patient passing away such as explaining the process after death, allowing relatives time to be with their loved ones for some time afterwards and just approaching the whole situation in a very professional way.”

People’s needs had been recorded in care plans. These outlined the support people required and took into account their preferences. Relatives or partners had provided information about people’s likes, dislikes and their backgrounds, to help ensure staff provided individualised care.

We found staff were responsive to people’s changing needs. Care plans were kept under review to help keep people safe and independent. Appropriate action was taken when people became unwell.

People were supported to take part in a range of activities to provide stimulation, enjoyment and social contact. The home had a team of activity staff and local volunteers who provided a programme of activities. There were also good links with the local community to help people keep in touch with their surroundings.

Monitoring of the quality of people’s care took place. However, actions were not always followed up where particular issues were identified, such as a high incidence of falls. The manager took action during the inspection to address this.

The service had informed us of incidents and notifiable occurrences, such as when people had died and any safeguarding concerns.

Records were maintained to a good standard and staff had access to policies and procedures to guide their practice.

We have made a recommendation about making the environment more stimulating for people with dementia.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staff support.

You can see what action we told the provider to take at the back of the full version of this report.

We returned to the service on 22 August 2013 to check whether improvements had been made. We found arrangements had been put in place to ensure there were enough skilled and experienced staff to meet people's needs.

Rotas and shift planning records showed the home was appropriately covered at all times. We saw more relief staff had been recruited since our last visit. This meant there were more staff who were able to cover gaps on the rota. For example, if other staff were on sick leave or annual leave.

We received positive feedback about staff. One person told us, 'Staff are excellent, I feel I've fallen on my feet.' A relative said, 'I can't praise staff enough, I think they're brilliant.' A visitor told us staff responded appropriately if their relative was ever unwell. They added, 'I can leave here knowing they will ring me if there's anything wrong.'

We were satisfied the home had taken sufficient action to become compliant with this standard.

We spoke to five staff and they demonstrated their knowledge about people's needs and had a clear understanding and awareness of how they should be met. We observed staff interacting with people, listening to them and responding to them in a polite and courteous way, ensuring that they gave people time to ask questions and respond at their own pace.

Staff had access to training and development and were supported through supervisions and performance reviews. At times the staffing levels were not as high as was desired, which impacted on staff and service users.

There were systems in place to monitor the quality of services provided. Records were completed and managed safely and securely.